Masui. The Japanese journal of anesthesiology
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To evaluate in man the potentiation by nitrous oxide of the neuromuscular blockade produced by pancuronium, pancuronium 0.025, 0.035, 0.049 or 0.068 mg.kg-1 was given during thiamylal-fentanyl anesthesia with and without nitrous oxide, and the evoked electromyography (EMG) of hypothenar muscle was measured. In the group receiving nitrous oxide the ED50 and ED95 were 0.0359 and 0.0691 mg.kg-1. In the group not receiving nitrous oxide, these values were 0.0389 and 0.0849 mg.kg-1. ⋯ It was also revealed that the magnitude of the blockade was influenced by dose, gender, nitrous oxide, lean body mass and body surface area by the multiple regression analysis. DRS for the female patients shifted to the left, and the differences between both sexes seemed to decrease in the group receiving nitrous oxide. It is concluded that the results of the present study appears to be similar to those obtained in the previous study on vecuronium using EMG.
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Case Reports
[Anesthetic management for cesarean section in patients with maternal myotonic dystrophy].
Myotonic dystrophy involves not only voluntary muscles of extremities, pharyngeal muscle and respiratory muscle but also smooth muscle in the gastrointestinal tract. This muscle involvement can cause difficulty in excreting sputa, delayed emptying time of stomach and regurgitation of gastric content, all of which can lead to disastrous complications of anesthetic management. ⋯ In one case, the newborn baby had dyspnea due to congenital myotonic dystrophy, and in another case, patient experienced postoperative pneumonia. Our cases and other reports suggest that spinal or epidural anesthesia is safely applied for a cesarean section of a patient with myotonic dystrophy.
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We report a case of tracheal rupture associated with use of a double-lumen endobronchial tube. The patient was a 58-year-old woman with metastatic carcinoma of the right upper lung lobe. Her trachea was intubated easily with a left-sided double-lumen endobronchial tube (Broncho-Cath, #35Fr). ⋯ A tracheal rupture, beginning 3 cm above the carina and 7 cm long, was noted at the membranous part of the trachea, and the cuff protruded partially from the ruptured trachea. The trachea was sutured, and a tracheostomy was carried out. Mechanisms of tracheal rupture related to double-lumen endobronchial tubes are discussed.
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Postcordotomy dysesthesia was classified from the clinical features of dysesthesia following percutaneous cervical cordotomy (PCC) in 66 patients. Dysesthesia occurred in 10 (15.2%) of 66 patients and was classified into three types. In the first type, dysesthesia occurred at the region where pain had been before PCC, and pain sensitivity had been lost due to PCC. ⋯ In the third type, dysesthesia occurred at the region where pain had been before PCC and pain sensitivity had partially recovered. This type of dysesthesia occurred in 3 patients. The reduction of the effect of PCC was presumably the cause of this type of dysesthesia.
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The relative accuracy of Thermoscan PRO-1 (Thermoscan, USA), an infrared ear thermometer, in an unadjusted mode was examined in 21 patients under general anesthesia, using the esophageal and tympanic membrane temperatures as the reference values. The correlation coefficient between the temperature measured by Thermoscan PRO-1 and the esophageal temperature, and that between the temperature measured by Thermoscan PRO-1 and the tympanic membrane temperature, were 0.953 and 0.942, respectively (P < 0.01). The "limits of agreement" between the temperature measured by Thermoscan PRO-1 and esophageal temperature, and between the temperature measured by Thermoscan PRO-1 and tympanic membrane temperature, were -0.5-0.4 degrees C and -0.5-0.5 degrees C, respectively. We conclude that Thermoscan PRO-1 is sufficiently reliable for monitoring body temperature during surgery.